Multidisciplinary Bariatric Programs

Obesity surgery has proven a remarkable tool in the hands of surgeons skilled at the procedures. No other tool or medication can prevent cancer and result in the resolutions of diabetes, hypertension, sleep apnea, arthritis, and polycystic ovarian syndrome. This list could go on and on. However, in 1991, the National Institutes of Health (NIH) recognized what so many surgeons were also realizing—that surgery alone did not work in everyone and that some patients would need more help than others. To do this, a more systematic approach to bariatric surgery would be needed.

Up until 1991, there was an ad hoc way of approaching the bariatric patient in the United States and around the world. Surgeons from all over the world often approached the workup for bariatric patients very differently. After the surgery, the care of the post-bariatric surgical patient varied from none to an extensive education and dietary program. It was not until the 1991 NIH consensus conference that surgeons, patients, and hospital systems began to demand that both surgeon and patient be part of programs that integrated multiple levels of care. For the NIH consensus conference, this meant a program with an integrated dietary regimen, appropriate exercise instruction, behavior modification, and psychological support.

After 1991, insurers also began to demand that any patient operated on by a surgeon must show that the NIH requirements were possible in their program prior to giving approval for an operation. This resulted in more programs around the country that integrated dietary, psychological support, exercise, and behavior modification.

These requirements worked well for a time. However, many surgeons, insurers, and patients realized that further work must be done to ensure good-quality outcomes both in surgery and after surgery. In 2002, the American Society of Bariatric Surgery formed the Surgical Review Corporation (SRC). This independent nonprofit group made up of surgeons, hospitals, and insurance providers would monitor all bariatric programs that voluntarily participate. Those who demonstrate that they are truly multidisciplinary and have excellent safety profile would be designated a Center of Excellence (COE).

Among the unique requirements that the SRC proposed was that both the surgeon and the hospital (or outpatient surgical center) must submit applications together to form a single Center of Excellence. Thus, tacitly admitting the fact the good outcomes happen not only because the surgeon is good but because the hospital systems are also important.

Currently, the SRC monitors all aspects of participating surgeons programs. When patients are seen in [Page 483]the hospital or the clinic, they verify that weight-appropriate furniture is available, and that there is adequate space for the handicapped. All people in the hospital and office who come in contact with these patients must show that they have received sensitivity training, that every patient has a psychological evaluation, and that each patient meets the standards for surgery outlined by the NIH. Additionally, complications are tracked in the hospital and weight-loss data are followed in the clinic. There must also be provisions for psychological support using support groups and each support group must be run by trained professionals. Some type of dietary program must exist. There are many more data points, but these highlight some of the most important ones.

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